Definition

What is retinopathy of prematurity?

Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants weighing about 1,250 grams or less that are born before 31 weeks of gestation (A full-term pregnancy has a gestation of 38–42 weeks).

The smaller a baby is at birth, the more likely that baby is to develop ROP. This disorder – which usually develops in both eyes – is one of the most common causes of visual loss in childhood and can lead to lifelong vision impairment and blindness.

How common is retinopathy of prematurity?

Not all babies who are premature develop ROP. Today, with advances in neonatal care, smaller and more premature infants are being saved.

About 90 percent of all infants with ROP are in the milder category and do not need treatment. However, infants with more severe disease can develop impaired vision or even blindness.

However, it can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of retinopathy of prematurity?

There are five stages of ROP:

Stage I: There is mildly abnormal blood vessel growth.

Stage II: Blood vessel growth is moderately abnormal.

Stage III: Blood vessel growth is severely abnormal.

Stage IV: Blood vessel growth is severely abnormal and there is a partially detached retina.

Stage V: There is a total retinal detachment.

The blood vessel changes cannot be seen with the naked eye. An eye exam is needed to reveal such problems. An infant with ROP may be classified as having “plus disease” if the abnormal blood vessels matches pictures used to diagnose the condition. Symptoms of severe ROP include:

Abnormal eye movements

Crossed eyes

Severe nearsightedness

White-looking pupils (leukocoria)

When should I see my doctor?

Early diagnosis and treatment can stop retinopathy of prematurity from worsening and prevent another medical emergency, so talk to your doctor as soon as possible to prevent this serious condition.

If your baby has any signs or symptoms listed above or have any questions, please consulting with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes retinopathy of prematurity?

ROP occurs when abnormal blood vessels grow and spread throughout the retina, the tissue that lines the back of the eye. These abnormal blood vessels are fragile and can leak, scarring the retina and pulling it out of position. This causes a retinal detachment. Retinal detachment is the main cause of visual impairment and blindness in ROP.

Scientists believe that the periphery of the retina then sends out signals to other areas of the retina for nourishment. As a result, new abnormal vessels begin to grow. These new blood vessels are fragile and weak and can bleed, leading to retinal scarring. When these scars shrink, they pull on the retina, causing it to detach from the back of the eye.

Risk factors

What increases my risk for retinopathy of prematurity?

In addition to birth weight and how early a baby is born, other factors contributing to the risk of ROP include anemia, blood transfusions, respiratory distress, breathing difficulties, and the overall health of the infant.

With newer technology and methods to monitor the oxygen levels of infants, oxygen use as a risk factor has diminished in importance.

Diagnosis & Treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is retinopathy of prematurity diagnosed?

All premature babies who fall within a screening protocol defined as birth weight less than 1500 g and gestational age of below 30 weeks are routinely examined for ROP. These premature babies will likely be examined initially at four to six weeks after birth. An eye doctor will use drops to dilate the pupils, which will allow for a better view of the inside of the eye.

Depending on the amount of abnormal blood vessel development, the baby’s condition will be graded and further examinations will be conducted every one to two weeks, depending on a variety of factors. These factors include the severity and location in the eye of ROP, and the rate of progression of blood vessel formation, called vascularization. In the majority of cases, even when ROP develops, it will resolve spontaneously with minimal effect on vision. However, a small percentage of babies screened for ROP, approximately 10%, will progress to the extent that it is no longer safe to wait for spontaneous resolution. For these babies, treatment will be offered to reverse the progression of ROP.

How is retinopathy of prematurity treated?

The most effective proven treatments for ROP are laser therapy or cryotherapy. Laser therapy “burns away” the periphery of the retina, which has no normal blood vessels. With cryotherapy, physicians use an instrument that generates freezing temperatures to briefly touch spots on the surface of the eye that overlie the periphery of the retina. Both laser treatment and cryotherapy destroy the peripheral areas of the retina, slowing or reversing the abnormal growth of blood vessels. Unfortunately, the treatments also destroy some side vision. This is done to save the most important part of our sightthe sharp, central vision we need for “straight ahead” activities such as reading, sewing, and driving.

Both laser treatments and cryotherapy are performed only on infants with advanced ROP, particularly stage III with “plus disease.” Both treatments are considered invasive surgeries on the eye, and doctors don’t know the long-term side effects of each.

In the later stages of ROP, other treatment options include:

Scleral buckle: This involves placing a silicone band around the eye and tightening it. This keeps the vitreous gel from pulling on the scar tissue and allows the retina to flatten back down onto the wall of the eye. Infants who have had a sclera buckle need to have the band removed months or years later, since the eye continues to grow; otherwise they will become nearsighted. Sclera buckles are usually performed on infants with stage IV or V.

Vitrectomy: Vitrectomy involves removing the vitreous and replacing it with a saline solution. After the vitreous has been removed, the scar tissue on the retina can be peeled back or cut away, allowing the retina to relax and lay back down against the eye wall. Vitrectomy is performed only at stage V.

Lifestyle changes & Home remedies

What are some lifestyle changes or home remedies that can help me manage retinopathy of prematurity?

The best way to prevent ROP is to avoid premature birth. Prenatal care and counseling can help prevent premature births and inform a mother about factors that influence her baby’s health in utero.

Other preventative interventions include closely monitoring oxygen needs in premature babies. Regular eye exams should be discussed with the baby’s physician, regardless of the stage of ROP.

If you have any questions, please consult with your doctor to better understand the best solution for you.